Department of Medicine , Imperial College London, NIHR CLAHRC for Northwest London , London , UK.
Imperial College NHS Trust, St Mary's Hospital , London , UK.
BMJ Open Respir Res. 2014 Jun 20;1(1):e000035. doi: 10.1136/bmjresp-2014-000035. eCollection 2014.
Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges.
An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project.
Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks.
Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to overcoming these barriers provides an opportunity to mitigate issues that waste time and resources, and ensures that training can be tailored to the anticipated challenges.
护理套餐已被证明可以改善结果，降低医院再入院率并缩短住院时间；因此，加快护理套餐的采用和实施速度应该是优先事项，以便更及时地改进和提供始终如一的高质量护理。先前的研究详细说明了获得套餐要素完全遵守的困难，但很少描述其根本原因。为了改进未来的实施，本文调查了实施慢性阻塞性肺疾病（COPD）护理套餐的临床团队所遇到的挑战，并描述了为克服这些挑战而采取的行动。
对七个临床实施团队的数据进行了初步回顾性文档分析，以审查临床团队面临的挑战。与医疗保健专业人员和管理人员进行了三次焦点小组讨论，探讨了项目中开发的解决这些挑战的方法。
文档分析确定了 28 个挑战，这些挑战直接影响了 COPD 护理套餐在五个主题中的实施：人员配备、基础设施、流程、改进方法的使用以及患者和公众的参与。焦点小组揭示了所有组都面临的五个最重大挑战：员工太忙、人员短缺、员工参与度低、套餐的工作量增加以及患者编码问题。参与者分享了克服问题的促进因素，包括：改变观念以提高参与度、增加更多的教育课程以提高员工参与度，并通过薪酬框架获得经理的认可。
最大限度地发挥护理套餐的影响取决于其成功和及时的实施。实施 COPD 护理套餐的团队遇到了所有团队和站点都普遍存在的挑战。了解和借鉴先前努力中面临的挑战，并确定克服这些障碍的促进因素，为避免浪费时间和资源的问题提供了机会，并确保培训可以针对预期的挑战进行调整。
